CASE REPORT Open Access
A giant lipoma of the parietal peritoneum:Laparoscopic excision
with the parietalperitoneum preserving procedure – a casereport
with literature reviewHanlim Choi1,2, DongHee Ryu1,2* , Jae-Woon
Choi1,2, Yanjie Xu2 and Yook Kim3
Abstract
Background: Lipomas are very common benign tumors of mature
fatty tissue that can occur in any part of thebody. However,
lipomas of the parietal peritoneum are extremely rare.
Case presentation: A 36-year-old man presented with urinary
frequency for 6 months. On computerizedtomography of the abdomen
and pelvis, a well-defined fatty mass measuring 20 × 11 × 6.5 cm in
size, was found inthe lower abdominal cavity. We performed a
laparoscopic parietal-peritoneum-preserving excision of the mass.
Thepatient was discharged without complications on post-operative
day 6.
Conclusions: To our knowledge, a laparoscopic excision with
preservation of the parietal peritoneum for a giantparietal
peritoneal lipoma has never been reported. Herein, we report a case
of a giant lipoma of the parietalperitoneum successfully managed by
laparoscopy.
Keywords: Giant lipoma, Laparoscopy, Parietal peritoneum,
Urinary frequency
BackgroundLipomas are very common benign tumors of maturefatty
tissue that can occur in any part of the body.There are a few
reports of giant lipoma of mesenteryor omentum [1–4]. However,
lipomas of the parietalperitoneum are extremely rare. And there
have beenno reports of extremely large-sized lipomas of theparietal
peritoneum. We describe a case of a giantlipoma of the parietal
peritoneum causing urinary fre-quency secondary to external
compression of thebladder. This tumor was successfully managed by
lap-aroscopic excision with preservation of the
parietalperitoneum.
Case presentationA 36-year-old man presented with urinary
frequencyfor 6 months. He had no significant urologic abnor-mality
and no palpable abdominal mass on physicalexamination. He denied
abdominal pain, vomiting,anorexia, or bowel disturbances. There
were nospecific laboratory abnormalities. The abdomen andpelvis
computed tomography scans showed a 20 × 11 cm,well-defined, fatty
mass in the abdominal cavity. A masswas located between the
abdominal wall muscles and theperitoneum and compressed bladder
(Fig.1a, b). We per-formed surgery, firstly. The reasons are as
follows: (1) themass was just beneath the abdominal wall, (2) the
patienthad symptom (urinary frequency), and (3) the mass
wasconsidered benign from well-demarcate mass withhomogenous
features on CT scan. We performed a lap-aroscopic mass excision
with preservation of the parietalperitoneum. Two 11-mm ports were
inserted, onesupra-umbilically, and the other in the left lower
abdo-men. A 5-mm port was inserted in the right lower abdo-men. A
huge, freely mobile, soft mass in the external
* Correspondence: [email protected] work was supported by
the intramural research grant of ChungbukNational University in
2015.1Department of Surgery, Chungbuk National University Hospital,
776,1sunhwan-ro Seowon-gu, Cheongju-si Chungcheongbuk-do 28644,
SouthKorea2Department of Surgery, Chungbuk National University
College of Medicine,Cheongju, South KoreaFull list of author
information is available at the end of the article
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the source, provide a link tothe Creative Commons license, and
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Dedication
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to the data made available in this article, unless otherwise
stated.
Choi et al. BMC Surgery (2018) 18:49
https://doi.org/10.1186/s12893-018-0382-7
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previous reports, all the patients presented with ab-dominal
pain. Three cases were presented with rightquadrant abdominal pain
mimicking appendicitis, andthe largest lipoma had a diameter of 6.3
cm [6–10].Our patient presented with urinary frequency causedby
external compression of the bladder. A huge andheavy lipoma
measuring 22 × 16 × 7.5 cm3 and 942 gdisturbed the filling capacity
of the bladder. In 4 previ-ously reported cases, because the
lipomas were small insize, they performed a laparoscopic excision
of the lipomaand its associated peritoneum [6, 8–10]. In our
case,we performed a peritoneal-preserving excision of thelipoma to
reduce the pain that we anticipated mightbe caused by peritoneal
resection. Since our patient’slipoma was large in size, we
dissected between theperitoneum and the lipoma, and the peritoneum
waspreserved with fixation around the abdominal wall.The fixation
device (Protack™, Medtronic) which isoften used in laparoscopic
hernioplasties, was usefulfor fixation. To our knowledge, a
laparoscopic exci-sion with preservation of the parietal peritoneum
fora giant parietal peritoneal lipoma has never been re-ported.
This procedure is feasible for decreasing post-operative pain and
better cosmetic results.In conclusion, this case highlights the
fact that a giant
lipoma of the parietal peritoneum can be an unusualcause of
urinary disturbances. Laparoscopic proceduresare feasible for the
excision of a huge lipomas of the par-ietal peritoneum, and
concomitant preservation of theperitoneum is useful for reducing
postoperative pain.
AbbreviationsA-P CT: Abdominal and pelvic computed
tomography
Availability of data and materialsAll data generated or analyzed
during this study are included in thispublished article and its
supplementary information files.
Authors’ contributionsAll authors participated in the management
of the patient in this casereport. YK assisted in diagnosing field
to the patient. DHR and JWC aresurgeons, who operated on the
patient, supervised and contributed to thecase report. HC and YX
researched and analyzed the data. HC was a majorcontributor in
writing the manuscript, collected all references. All authorsread
and approved the final manuscript.
Ethics approval and consent to participateNot applicable.
Consent for publicationWritten informed consent was obtained
from the participant for publicationof this article and any
accompanying tables/images. A copy of the writtenconsent is
available for review by the Editor of this journal.
Competing interestsThe authors declare that they have no
competing interests.
Publisher’s NoteSpringer Nature remains neutral with regard to
jurisdictional claims inpublished maps and institutional
affiliations.
Author details1Department of Surgery, Chungbuk National
University Hospital, 776,1sunhwan-ro Seowon-gu, Cheongju-si
Chungcheongbuk-do 28644, SouthKorea. 2Department of Surgery,
Chungbuk National University College ofMedicine, Cheongju, South
Korea. 3Department of Radiology, ChungbukNational University
Hospital, Cheongju, South Korea.
Received: 9 March 2018 Accepted: 24 July 2018
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Table 1 Reports regarding the treatment of a lipoma of the
parietal peritoneum in the literature
Reference (year) Age (years) Sex Presentation Surgical procedure
Maximumdiameter (cm)
Barut et al. [4] (2006) 67 Female Abd pain, nausea vomiting Open
6
Bunker et al. [5] (2013) 34 Female Abd pain Laparoscopy –
Bang et al. [6] (2014) 75 Male Abd pain, palpable mass Open
4.5
Shrestha et al. [7] (2014) 32 Male Abd pain, loss of appetite
Laparoscopy 3
Sathyakrishna et al. [8] (2014) 21 Female Abd pain Laparoscopy
–
Salgaonkar et al. [9] (2016) 79 Male Abd pain Laparoscopy
6.3
Present case (2018) 36 Male Urinary frequency Laparoscopy 22
Choi et al. BMC Surgery (2018) 18:49 Page 3 of 3
https://doi.org/10.1155/2013/587380https://doi.org/10.1093/jscr/rju062https://doi.org/10.7860/JCDR/2014/9663.4728https://doi.org/10.7860/JCDR/2014/9663.4728
AbstractBackgroundCase presentationConclusions
BackgroundCase presentationDiscussion and
conclusionsAbbreviationsAvailability of data and materialsAuthors’
contributionsEthics approval and consent to participateConsent for
publicationCompeting interestsPublisher’s NoteAuthor
detailsReferences